Knee Pain Case studies
Over the past 20 years as a physiotherapist, I've helped thousands of people recover from a wide variety of knee pain issues.
As a 25-year-old construction worker in rural Australia, John agreed to help a friend work on the roof of his parents’ boathouse. However, as John was working, he slipped and fell off the roof. Very unluckily, his neck smashed into the keel of an upturned dinghy; and his friend looked down to see John on the ground, with his head facing up, and his body facing down. He had broken his neck and badly damaged his spinal cord.
Amazingly, John was still alive when he arrived at the local hospital. Miraculously, there was a young spinal surgeon visiting! John was his eighth patient, and the surgery took eight hours to complete. When John awoke, it was to the news that although they’d been able to save his life, he would be paraplegic, with no movement or feeling in any of his limbs.
However, six weeks later, as he lay in his hospital bed, John felt a flicker in his thumb. The next day, he felt two flickers. His body was (very) gradually coming back to life!
It turned out that John had sustained a partial rupture of his spinal cord, and not a complete rupture. He recovered the use of some of his muscles, but by no means all. But John is an extremely resourceful and persistent chap, and over the next 10 years, he stubbornly taught himself to walk again, albeit with a very severe limp.
Fast-forward 25 years from the accident. John was now 50, living in London and working in the banking sector. He was still able to walk, but because of the severe limp and loss of muscle control, his body was starting to wear out. His right knee was excruciatingly painful, and his ligaments had stretched so far that at each step, his knee collapsed backwards by 40 degrees!
He went to see a knee surgeon, the very sensible Ian McDermott, who told him that although technically he could repair the overstretched ligaments, if John continued to walk as he was doing, then the surgery would be wasted as the repaired ligaments would simply stretch again, and a second repair might not be possible. Instead, Mr McDermott recommended that John come to see me to try to sort out his walking gait.
When I first saw John, he was wearing a knee brace, which was supposed to stop his knee from collapsing; and an ankle brace that was supposed to hold his foot steady. He was also using a walking stick. His quadriceps and glute muscles (front of thigh and buttocks) were wasted to almost nothing, and his foot was badly twisted.
I did not know how much I would be able to help John; but this was certainly a challenge, and I was up for it! I felt that the first thing was to get John’s foot planted better on the floor, and to start getting his glutes activating, so that his knee didn’t collapse inwards with every step.
John worked incredibly hard at his exercises, and over the next few months he continued to exceed my expectations. After a few sessions, we were able to remove first his knee brace and then his ankle support – I made him an insole instead. His knee control improved and his trust in it grew. His walking gait became more controlled, faster and less painful. Amazingly, his knee ligaments actually seemed to shorten, and after a few months, he was not even able to hyperextend his knee to 20 degrees, let alone 40!
John’s walking gait will never be normal – his spinal cord has been severely damaged, and he will never have normal muscle control. But through his own hard work, with a bit of direction and input from me, he has avoided the need for major knee surgery, is much less reliant on his stick, and is able to walk for 2-3 hours at a time, whereas previously he was in pain at every step – a fantastic result which has improved his quality of life significantly.
Sonal, a 48-year-old lawyer, came to me on the advice of her knee surgeon. He had operated on her right knee 18 months earlier – a routine procedure to tidy up some torn cartilage – but she was getting worse despite having weekly physiotherapy. She was in despair, walking as little as possible (using two crutches to get about) and even worse, her left knee was starting to become painful, and she was terrified at the prospect of more surgery.
Sonal told me that her physio had been focusing on making her train her leg muscles – her quadriceps, hamstrings and gluteals.
However, when I looked at her whole body, it was clear that both of her knees were collapsing inwards, and that this was actually happening because of her feet. Her foot muscles had become too weak to support her; and over time, her feet had stiffened into a collapsed position, and her control was even worse when she was standing on one foot than when she was on both, putting a terrific strain on her knees when she walked. As a result, at the point I met Sonal, even if she’d had the world’s strongest thighs and glutes (which she didn’t!), she wouldn’t have been able to support her knees properly.
Amazingly however, as soon as I got my hands onto her feet, got her foot joints a bit more mobile and then supported her arches, her knee pain decreased immediately. The change was so dramatic that when we walked back out from the treatment room into reception, for the first time in two years, Sonal wasn’t using her crutches! What seemed like her entire family were waiting for her; and when they saw her walking without support, albeit slowly and carefully, the whole room burst into tears.
I worked with Sonal for 12 sessions over the course of 9 months, and the improvement was significant. She worked hard on her foot mobility and muscle activation, and I prescribed temporary insoles to give her support. Within two months she was using an exercise bike, and her new glute exercises were starting to take effect. Two months after that, she went dancing in high heels at a friend’s wedding! And by the time I discharged her, she was regularly enjoying going to the gym and swimming, and a year later, she hasn’t needed any further treatment.